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NPI Code Detail

MEDICARE: RYAN MICHAEL FULLER R.PH

MEDICARE: RYAN MICHAEL FULLER R.PH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist26019085AIN

General Provider Information

NPI Number : 1962839282
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN MICHAEL FULLER R.PH
Provider Business Mailing Address
First Line : 9010 MICHIGAN RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-3184
Country : US
Telephone Number : 317-532-1607
Fax Number :
Provider Business Practice Location Address
First Line : 9010 MICHIGAN RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-3184
Country : US
Telephone Number : 317-532-1607
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2013
Last Update Date : 10/01/2013

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